ALISHA PROVOST DO Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125078497

License Status

EXPIRED

Business

Title

First Name

ALISHA

Last Name

PROVOST

Business Name

ALISHA PROVOST DO

Original Issue Date

07/01/2021

Effective Date

07/01/2021

Expiration Date

06/30/2024

City

O’FALLON

State

Zip

62269

County

SAINT CLAIR

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

10/30/2024